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Healthcare administrators use various financial management tools for analyzing processes, mapping out performance objectives, reviewing case rates, and reviewing pay-for-performance incentives.

Use Google Spreadsheet or Microsoft Excel, along with what you have learned in Chapters 1 through 4, to chart, outline, or diagram at least three policies and/or processes that you, as a healthcare administrator, have determined need improvements. Examine the policies and/or processes that you identified within your discussion in Module Three for this activity. In order to gather three policies and/or processes, you will need to choose policies and/or processes that your classmates identified as well. Then, organize these three policies and/or processes, as well as your justification for selecting each You may use the Module Four Activity Template for this assignment, but using the template is not required.

Upload your chart as an XLS file (Excel or Google Spreadsheet or equivalent).

This activity will help you prepare for Milestone Two.

For additional details, please refer to the Module Four Activity Guidelines and Rubric document.

Rubric attached.Running Head: FINANCIAL PRINCIPLES AND REIMBURSEMENT
FINANCIAL PRINCIPLES

Financial Principles and Reimbursement
Maria Williams
Southern New Hampshire University
October 3, 2020

Financial Principles and Reimbursement Report

Healthcare administrators play a significant role in today’s healthcare settings-they ensure equitable access to quality healthcare through effective leadership. They manage financial responsibilities within healthcare organizations. Hence, healthcare administrators must prioritize the value of service reimbursement because it is a major component of financial wellbeing in healthcare organizations. Effective management of reimbursement can enhance a healthcare organization’s revenue, which depends on the number of patient visits, the type of treatment offered, and their insurance coverage. This report assesses the impact of different reimbursement methods and strategies on an organization’s strategic plan. It also covers other important areas significant for effective operations such as financial management principles, management of accounts receivables, teamwork, and maximization of reimbursements.

Reimbursement Strategies

Patients are willing to pay for exceptional healthcare service if healthcare organizations perform and offer high quality healthcare services. One of the most commonly used reimbursement strategies employed by hospitals and other facilities is the pay for performance approach. Casto (2018) indicates that pay for performance is a type of payment arrangement used to reimburse providers and includes incentives. The pay for performance measurement can be targeted to individual physicians or a healthcare organization. While pay for performance consists of fee for service and capitation payment approaches, it also incorporates increase in payment and other incentives to providers based on quality and efficiency. Case rates such as increases in hospital visits can affect pay for performance in the form of bonuses and direct incentives to healthcare providers. Utilization of data such as increase in healthcare costs, cost of equipment and drugs, and economic performance can also influence pay for performance incentives.

Reimbursement Methods

There are three major reimbursement methods for healthcare organizations- fee for service, capitation, and discounted fee for service. Under fee for service, doctors are paid for each service and test they provide based on customary charges of doctors in a given local area (Rudmik, Wranik & Rudisill-Michaelsen, 2014). A healthcare organization can use this strategy to provide high healthcare services by hiring experts on contract basis. However, administrative costs would vary depending on the volume of expert services offered during a given period of time. In discounted fee for service doctors are paid for every service and test offered based on predetermined discount of customary prices prevailing in a given area (Hagland, 2014). HencIHP 630 Module Four Activity Guidelines and Rubric

Overview: Healthcare administrators use various financial management tools for analyzing processes, mapping out performance objectives, reviewing case
rates, and reviewing pay-for-performance incentives.

Prompt: Use Google Spreadsheet or Microsoft Excel to chart, outline, or diagram at least three policies and/or processes that you, as a healthcare administrator,
have determined need improvements. Examine the policies and/or processes that you identified within your discussion in Module Three for this activity. In order
to gather three policies and/or processes, you will need to analyze policies and/or processes that your classmates identified as well. Then, organize these three
policies and/or processes, as well as your justification for selecting each. You may use the Module Four Activity Template for this assignment, but using the
template is not required.

Guidelines for Submission: Upload your chart as an XLS file (Excel or Google Spreadsheet or equivalent). You should follow current APA-style guidelines.

Critical Elements Exemplary (100%) Proficient (90%) Needs Improvement (70%) Not Evident (0%) Value

Visual Aid Meets “Proficient” criteria and
demonstrates professional skills
in visual aid creation

Creates a visual aid that clearly
communicates the policies
and/or processes that need
improvements

Creates a visual aid that
articulates the policies and/or
processes that need
improvements but is inaccurate
and/or lacking details

Does not create a visual aid that
articulates the policies and/or
processes that need
improvements

20

Analyze Meets “Proficient” criteria and
includes a variety of scholarly
evidence as support for the
visual aid

Analyzes and determines
policies and/or processes that
need improvements

Analyzes and determines
policies and/or processes that
need improvements but is
inaccurate and/or lacking
details

Does not analyze or determine
policies and/or processes that
need improvements

35

Justification Meets “Proficient” criteria and
supports justification with
explicit details

Justifies the rationale behind
selection of policies and/or
processes that need
improvements

Justifies the rationale behind
selection of policies and/or
processes that need
improvements but is inaccurate
and/or lacking details

Does not justify the rationale
behind selection of policies
and/or processes that need
improvements

35

Articulation of
Response

Submission is free of errors in
organization and grammar

Submission is mostly free of
errors of organization and
grammar; errors are marginal
and rarely interrupt the flow

Submission contains errors of
organization and grammar, but
errors are limited enough so
that the submission can be
understood

Submission contains errors of
organization and grammar
making it difficult to understand

10

Total 100%

http://snhu-media.snhu.edu/files/course_repository/gIHP 630 Final Project Guidelines and Rubric

Overview
The final project for this course is the creation of a payment system and reimbursement method analysis and a report to management.

The healthcare industry is impacted by government payer types as administrators prepare strategies and implement internal procedures designed to maximize
reimbursement. You are reminded that the primary focal point between healthcare firms and other business operations is the payment method. Healthcare
administrators implement strategies designed to meet key performance payment requirements critical for government compliance and reimbursement
guidelines. One way administrators accomplish this is to analyze deficiency errors based on quality measures performed by providers, nursing staff, and front
desk operations. The Affordable Care Act and other changes in legislation are of continual concern for healthcare organizations as administrators review changes
to ensure organizational processes and internal policies are implemented.

Your final project for this course is an analysis with recommendations. The project will require you to prepare an analysis of payment systems and reimbursement
methods. You will compare and contrast your findings and offer subsequent recommendations. You will consider compliance and government regulations along
with financial principles associated with reimbursement. You will also identify collaborative teamwork strategies that can be incorporated into various healthcare
settings.

The project is divided into three milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final
submissions. These milestones will be submitted in Modules Three, Five, and Seven. The final submission is due in Module Nine.

In this assignment, you will demonstrate your mastery of the following course outcomes:

 Assess the extent to which healthcare organizations utilize financial management principles for guiding strategic planning

 Analyze federal, state, and third-party payer regulations and reporting guidelines for ensuring compliance with healthcare reimbursement requirements

 Recommend collaborative teamwork principles for improving strategic planning processes involving healthcare reimbursement

 Suggest financial approaches for improving cash flow, days in accounts receivable, and timeliness of reimbursements from various healthcare payer
models

 Recommend strategies for maximizing healthcare reimbursement by reviewing the impact of case rates and management utilization data on pay-for-
performance incentives

Prompt
Your analysis with recommendations should answer the following big-picture questions: What reimbursement payment methods and strategies are associated
with the healthcare industry? How do financial management principles relate to reimbursement in evaluating operational performance? And, how does the
revenue cycle affect various deparSheet1

Process/Policy Rationale for Selection

1 Click on this cell and type the name of the process/policy here. Click on this cell and type the reason for the process/policy selection here.

2 Click on this cell and type the name of the process/policy here. Click on this cell and type the reason for the process/policy selection here.

3 Click on this cell and type the name of the process/policy here. Click on this cell and type the reason for the process/policy selection here.

Note: You may edit this document with visual cues, such as color and type styles, in order to make your visual aid more clear.

  
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